Children reading books in fieldDiversity, Equity and Inclusion

A Team-Focused Strategy to Tackle Tough Topics

By: Lauren Dominique

Team members of Connecticut Children’s Office for Community Child Health (the Office) recently embraced an opportunity to participate in a shared reading and discussion group to advance their understanding of the ongoing inequities faced by people of color. The team was invited by the Office’s Equity Committee to partake in a “book club” focused on racial and social justice in honor of Black History Month. The Equity Committee was recently formed as one of the Office’s 2021 goals to raise awareness of inequality and promote equity in our office community.

Participants read “Black Man in a White Coat” by Damon Tweedy, MD, before coming together in the last week of February to share our reactions and takeaways as a group.

In his memoir, Dr. Tweedy sheds light on his experiences as a Black student at Duke University’s School of Medicine and, ultimately, as a practicing physician.

Inequities Experienced as a Student

One of the first experiences Dr. Tweedy shares is from his first year at Duke. Tweedy is in class when the professor pauses his lecture and dismisses the students for a brief break. When Tweedy returns to the lecture hall, he is confronted by the professor who has mistaken him for a maintenance worker. The professor, clearly irritated, asserts that he has been waiting weeks for someone to fix a flickering light. Tweedy froze before correcting the professor, “No, I don’t have anything to do with that.” The professor scowled and demanded to know if Tweedy did not come to fix the light, then what was he doing there? Tweedy replied, “I’m a student… in your class,” to which the professor, without embarrassment or apology, simply turned and walked to the front of the hall to resume class.

This is just one of many instances where Tweedy has his presence questioned because of his skin color. Later, some patients, who never bat an eye at the white doctor in the room, would drill Tweedy with questions regarding his credentials. Others would ask if he was in the right place or if he was actually a basketball player dressed in a doctor’s costume.

Time and time again, this reinforced for Tweedy that, in a room of white peers, he could not just be equal to – he had to be more than.

After the encounter with his professor, Tweedy sacrificed sleep and socializing to focus every waking hour on studying. It paid off in the end when his final exam scored second highest in the class. When Tweedy entered his professor’s office, the professor was clearly shocked to put the name and grade of the exam to Tweedy’s face, but congratulated him nevertheless, and even invited Tweedy to serve as his research assistant (an invitation that Tweedy declined). For this professor, it was only Tweedy’s academic rigor and success that set him apart from a maintenance worker there to fix the lights.

This stood out to our book club, which was primarily made up of white participants (myself included). Many of us had not previously considered how our colleagues of color need to work even harder to prove themselves as capable in their positions. It begged the question, in the situations where we already feel the pressure to perform, how must that feel for our BIPOC colleagues?

We were also struck by the dilemma Tweedy faced: Does he focus his efforts on becoming “more than” his peers – studying so he can perform better than them? Or does he channel his energy into addressing the larger issue that, compared to their white counterparts, people of color have to meet greater expectations to be seen as equal? Is he obligated to be a martyr for equality just because he is Black? Is he failing the Black community if he chooses not to?

Once again, personal ambition and comfort trumped racial solidarity. Learning to be a doctor was hard enough without my trying to change the whole system too. Further, I didn’t want to deal with possibly being mislabeled as racially paranoid, especially considering how deeply most educated white people take offense to being accused of racial bias. But was I selling myself, and my race, short in the process? 

Damon Tweedy, MD – “Black Man in a White Coat”

Inequities Endured by Patients

In addition to Dr. Tweedy’s lived experiences of prejudice and microaggression, his memoir also touches on social determinants of health and amplifies how socioeconomic disparities are often a racial issue.

This was highlighted in various settings throughout his third year of medical school into his residency. The first we see is at a community clinic in a local town, about an hour away from Duke’s campus. The small building wasn’t designed to be a medical center, so the clinic space was makeshift; the “rooms” were separated by curtains instead of walls, and the waiting area was outside on a front porch.

The town had limited access to healthcare services, and patients came to the clinic without health insurance. For many, this free clinic was their only opportunity to meet with a doctor and Tweedy could not ignore the fact that all the townspeople who came to this clinic were Black.

Since it was a volunteer-based clinic, the medical staff changed from week to week, so patients rarely, if ever, could build a rapport with their care provider. Medical supplies were limited, which meant patients served at the end of the day sometimes had to go without the medication they needed. Despite the best efforts of the medical students and residents who ran the clinic every other week, the lack of quality care resulted in patients’ medical conditions rarely ever improving.  

Inequities Observed as a Physician

At Duke University Hospital, racial disparities came to light in another way. Dr. Tweedy recalls a staggering example of racial discrimination and prejudice during his internship.

A Black man named Gary came to the emergency department with chest pain. After taking tests and evaluating the results, Tweedy accompanied two white doctors to the examination room to discuss Gary’s next steps. In addition to quitting smoking and taking a daily aspirin – both things Gary agreed to do – the doctors wanted to prescribe him a daily medication for his high blood pressure. Gary was hesitant to start the medication and explained to the doctors that he would like to first try managing his blood pressure by improving his diet and exercise regimens. He understood that his blood pressure numbers meant he had mild hypertension, and he knew that these lifestyle changes had been proven effective in managing mild cases.

Tweedy witnessed the doctors respond to Gary with condescension and irritation – a manner in which he had not seen them treat a white patient. After minutes of lecturing Gary on why he should take the medication, they finally seceded and agreed to discharge him without the blood pressure medication. However, upon leaving the room, the doctors joked about Gary having some psychiatric disorder as if that were the only explanation as to why he would disagree with their recommendation to medicate. However, the comment did not end as a joke; one of the doctors included it in Gary’s discharge summary. Now, whenever a doctor reviewed his medical history, they would make assumptions about him not only as a Black man but as a Black man with a psychiatric disorder.

How Shared Reading and Discussion Can Promote Inclusivity

Before our book club, many of us understood socioeconomic status being a social determinant of health and were equally aware of the deep roots of racial discrimination in our country and healthcare systems. But what many of us were not aware of is how these health and racial disparities have nuanced implications for Black medical professionals.   

Certainly I owed it to all the patients I saw to be as competent and compassionate as I could. But as a black doctor […] did I owe black patients something more beyond my clinical expertise? Was it my role to try and help fix these disparities? 

Damon Tweedy, MD – “Black Man in a White Coat”

The moments I have recalled in this post are merely snapshots of inequities brought to the surface in Tweedy’s narrative. I sincerely encourage you to take the time to read this work and truly reflect on the stories Tweedy shares about his own life and the lives of the patients he was witness. This memoir is enticing and well-written, and it brings a sobering awareness to the many ways racial inequities manifest within the medical field. With that awareness, it guides readers to think about how we can address these issues and commit to advancing equity.   

Overall, Damon Tweedy’s “Black Man in a White Coat” opened my eyes to the pressure placed on people of color to lead social justice reform. Throughout this memoir, Dr. Tweedy struggled with his role in addressing racial inequities and the ensuing health disparities, as if the color of his skin made him responsible for fixing the problem. 

Reading this book sparked feelings of increased accountability to alleviate the burden placed on people of color to be the changemakers and champions of racial equity. We all need to be mindful that it is not the responsibility of people of color to fix the systems that oppress them. It is up to the white colleagues and leaders within organizations, myself included, to reflect on the existing systems that uphold our privilege and mobilize to create systems-level changes that promote a more inclusive workplace, and ultimately, a more equitable society where advancing health outcomes and increasing access to quality health care are priorities.

We have to challenge our thoughts and preconceptions of BIPOC that have been ingrained in us for far too long and challenge our families, friends, and colleagues to do the same. We have to think critically about how existing systems must change and we must take action in making it happen. We can only commit to achieving equity by treating one another, regardless of race, with dignity.

 A big part of the solution is discarding your assumptions and connecting with each patient as a person. Race, while certainly a powerful influence, by itself doesn’t guarantee a human connection any more than any other factor like geography, height, or handedness. 

Damon Tweedy, MD – “Black Man in a White Coat”

Lauren Dominique is the Executive Associate in Connecticut Children’s Office for Community Child Health and a member of the Office’s Equity Committee. 

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